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Notes, Comments, and Abstracts.CARE OF THE SCHOOL-CHILD.
IN an address on child guidance delivered before the- Child Study Society on Feb. 16th Sir Humphry Rollestonsaid that the word " education." which connoted preparationfor future life, should be used to include the development ofboth physical and mental capacities, for these were closelyinter-related, and must be wisely balanced. The difficultyof arranging the routine of school-life was that childrenall differed in their individual capacities, whilst from thepoint of view of the school it was necessary that there shouldbe a uniform and systematic plan, and individual license must be comparatively small. The necessary limitationsof the school had to be compensated for by the freedomof the holidays, and the urgent need for these holidays was-often shown by the way in which children flagged in the.second half of the term. During adolescence there was aninverse ratio between physical growth and mental efficiency,and when a child was growing rapidly its mind did notkeep pace. Schoolmasters often reported about the age ofpuberty that a child was fidgety, inattentive, and could domuch better ; but if a boy was not doing well, the factshould be accepted philosophically by the parents as anindication that he was growing, and not as a sign of vice.Boys did not develop at the same rate, and the rate at whichthey blossomed out was no assurance of how long they would.continue to bear fruit. It was important to remember thatthe young, however callous and defiant they might appear,were really extremely sensitive and impressionable, andtheir self-respect and spirit were often worn down by depre-catory comparisons, and by the constant snubs of school-masters and parents. There was always a tendency tolive up to the character one was given, and sympathy and-understanding was seldom wasted upon backward children.
It was a serious matter, continued Sir Humphry, to curtailthe necessary hours of sleep of growing boys and girls,and these should be 11 hours for a child up to the age of10 years, and 9 hours up to the age of 17, both theseminima being increased during the winter months. Insuffi-ciency of sleep, tantamount to overwork, favoured mentalinstability and rendered a child liable to the inroads ofdisease. The young, clever boy who was high in the schoolfor his years, ought to sleep in a dormitory for boys of hisown age. Better results had also been obtained in thematter of winning scholarships by reducing the amountof time that boys were supposed to be working ; the characterof the work done and the health of the pupils were alsoimproved by prolonging the rest periods between the hoursof work. As far as possible all out-of-school work should beavoided, and punishments which involved keeping childrenin the school-room were quite wrong. Discipline had to bemaintained, and he considered that corporal punishmentwas a perfectly right correction so long as a master, beforeinflicting it, made full inquiries ; the immediate boxing of<ears and twisting of arms should, of course, be abolished.The fact that children developed at different rates madethe question of over-pressure and over-work in schools adifficult one. The effects of over-pressure of the brainwere more important than the effects of over-pressure of thebody, and whereas it was difficult to over-strain a perfectlyhealthy child by physical exercise, there was much lessreserve power in the nervous system.
In the subsequent discussion Dr. Letitia Fairfield said thatin England she thought it extremely rare to see cases of over-work in a child, and they were usually associated with someemotional disturbance outside school life. It was interestingto note how retardation at school might spring from remoteemotional causes. In America, however, things were different.From the beginning of their school lives children broughtback reports to their parents which were taken extremelyseriously, and promotion in the schools was automatic, achild remaining behind being in disgrace. The gay littleslacker of our schools who did not want to learn was severelylacking in American schools.
" METALIX " X RAY TUBES.WE have received from Philips Lamp, Ltd. (145, Charing
Cross-road, London, W.C. 2), an illustrated brochure showingthe various types of " Metalix " X ray tubes which are nowavailable. A remarkable feature of the brochure is that itgives illustrations of X ray apparatus by a number ofdifferent manufacturers. From their design " Metalix "
tubes facilitate protection to the operator, an advantageof which manufacturers have not been slow to avail them-selves. The benefit is shared by the purchaser, for thecost of putting heavy protective material on moving pa.rtshas meant a big outlay. The time since the introductionof these tubes may be too short to pass any final verdicton their lasting qualities, but extended use by medical mensuggests that they are coming up to expectations.
THE INFLUENCE OF PROSPERITY ON HEALTH.AT a meeting of the Royal Statistical Society on Feb. 21st
Dr. T. H. C. Stevenson, of the General Register Office,read a paper on Vital Statistics of Wealth and Poverty.Many attempts, he said, have been made to estimate theinfluence upon health of prosperity and the lack of it, butthe extent of our ignorance of the subject attests thedifficulties of its investigation. The method most commonlyemployed has been the comparison of returns for completepopulations selected as representing wealth and poverty.But the samples so secured are very far from pure, or freefrom influence by other factors than that under investiga-tion. If the contrasts in wealth, and, what is probably quiteas important in its influence on health, culture, are to beobvious, the numbers available for examination will belimited ; and on the other hand, if the field of investigationis extended the difficulty of assessing degree of local wealthand culture becomes formidable. Classification of indivi-duals by income is not possible under present conditions inthis country, though it has been employed on a very limitedscale in some American investigations. Estimation ofpoverty by housing conditions is very unsatisfactory, as badhousing is only one of the handicaps of poverty, so that it isimpossible to determine how far the excess of mortalityassociated with bad housing is due to poverty and how farto the direct effects of overcrowding and other factors.Even if full details of income were available, these in
themselves would not provide an ideal basis of classification,as it is probably rather the cultural associations of wealthwhich promote longevity than wealth itself. The clergyare, for the most part, poorly paid, but they are singularlyhealthy. The method which Dr. Stevenson advocated ason the whole best meeting the conditions to be consideredis that of inferring social position from occupation. Bythis means regard can be paid to (average) culture as wellas income, and the total occupied population can be includedin the inquiry. The results attained by a scheme based onthese lines are described in the recent report of the Registrar-General on Occupational Mortality during 1921-23, and theregularity and consistency of the graduation so obtained ofmortality from various causes is held to be in itself evidenceof the success of the social classification so arrived at.Dr. Stevenson quoted instances of such regularity, mortalityfrom many forms of disease increasing without interruptionfrom a minimum in the highest to a maximum in the lowestsocial class. Respiratory diseases, including phthisis, furnish,he said, the most pronounced examples of this type ofdistribution, which tends to be reversed for diseases of thedigestive system, and for diabetes in later life, mortalityfrom appendicitis increasing without interruption from aminimum for the lowest to a maximum for the highest ofthe five social classes distinguished. The case of cancer isespecially interesting. Mortality from this cause follows theusual type of social distribution, being lowest in the highest,and highest in the lowest, section of society. But thisgradation is found to apply to cancer of certain sites only,mortality from the remainder being much the same for allclasses. The graded sites, which are responsible for abouthalf the total deaths (in males, for whom alone the requisiteoccupational information is available), includes the upperalimentary canal from mouth to stomach inclusive, the skin,and the larynx. It would therefore appear that cancer ofthese sites is largely preventable, though the factors deter-mining its differential incidence will have first to be recognised.
In conclusion Dr. Stevenson suggested certain further usesfor a social classification based on occupation, includinginvestigation of the tendency of various sections of societyto increase or decrease and be replaced by others.
RECIPES FOR LIVER DIET.THE fact that those undergoing liver regimen have to eat
large quantities of the food makes it imperative that asmuch variety as possible should be found in the ways ofserving it. We have already referred to a collection of Irishrecipes 1 and a booklet has now reached us entitled " Liver :Nutritive Value and Ways of Serving " (Department ofHome Economics, Institute of American Meat Packers,509, South Wabash-avenue, Chicago), which contains40 American recipes for serving this article of food, adaptedto the three principal meals of the day, all of which can beused in the home, and most of which are applicable tohospitals and institutional dietaries. Two examples may begiven ; the first is for baked liver, Swedish style, thesecond for stuffed cabbage leaves :-
Ingredients.—1 lb. beef liver ; fiour to dredge ; salt, pepper ;1 cup cream or milk ; 2 apples, sliced ; 6 prunes, cooked andstoned ; 2 tablespbons butter ; 3 slices bacon. Method.—Selecta thick piece of liver. Soak over night or for several hoursin a marinade dressing or in buttermilk. Cut liver on thickside to form a pocket, sprinkle cavity with salt and pepper,then fill with fruit and broken bits of butter. Sew or skewer
1 THE LANCET, Jan. 14th, p. 113.
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liver together. Make several cuts about t inch deep on outertop surface of liver, dredge with flour, wrap with strips ofbacon, and skewer into place. Put in a baking dish, add cupwater, and bake 2 hours in a moderate oven (325° F.), basting 1occasionally. When done, place liver on a platter and garnish." ;Thicken liquid in pan, add cream or milk and seasonings, andserve with meat.
Ingredients.-1 cup liver, chopped or ground ; 2 tablespoonsbacon fat; 1 cup tomato juice or stock ; 1 cup cooked rice ;1 beaten egg ; teaspoon celery salt ; 1 teaspoon salt ; dash of ]nutmeg or cinnamon ; 1 small onion, minced ; 10 to 12 cabbageleaves. Method.-Remove the outer leaves of a cabbage head,wash, then cover with boiling water and cook for 3 to 5 minutes,or until the leaves begin to look transparent. Combine theliver, rice, beaten egg, bread crumbs, 1 tablespoon each ofbacon fat and onion, and seasonings. Mix thoroughly. Removecabbage leaves from water, drain, and on each leaf place a largetablespoonful of the liver mixture. Roll and fold each cabbageleaf, and then tie with string or fasten with toothpick. Meltrest of bacon fat in a deep frying pan, brown slightly the restof the onion and lay on it the filled cabbage leaves. Pour overthem the stock or tomato juice, cover, and cook slowly over alow fire 1 hour or bake in a moderate oven (375° F.) 45 minutes.If fat is limited in the diet, omit it in the recipe and scant theamount used for browning.
MIDDLE-AGED SPRINTING.
Dr. F. E. Fremantle, M.P., has an interesting note in arecent issue of the Journal of the London Athletic Clubupon the health value of running as a recreation. Hedescribes the cross-country runs which he and his con-
temporaries at Guy’s Hospital took regularly, and he givesit as his experience that all the men sufficiently fit to under-take these runs benefited much by them, although heallows that the physical strain was exacting when the arduouslife of the medical student had to be conducted at thesame time. Contemplation of the breakdown of friends inmiddle life leads him to the reflection that they might havekept their health if they had learned early the value ofcross-country running, indulged in it reasonably and prac-
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tised it, or some analogous exercise, throughout life. Thevalue of a daily sprint of a hundred yards is alluded to askeeping the heart trim and the circulation in good order,but we are sure that he would recommend those of hismiddle-aged friends who have already begun to show signsof circulatory trouble to avoid this particular form ofexercise whenever possible—never, in short, to run fora train.
NEW PREPARATIONS.
WE have received samples of T1’icalcine from the laboratoryof Dr. Perraudin in Paris (Agent : Wilcox, Jozeau et Cie,Great St. Andrew-street, London). The drug has beendesigned to supply certain mineral elements necessary tohuman alimentation when deficiency is diagnosed, particu-larly if it can be traced to faulty dietetic methods. Thecalcium preparation is supplied pure or in association withadrenalin, with methylarsenate of soda, or with fluoride ofcalcium, according to the condition for which the recalcifyingtreatment is made. Great claims are made for the remedyin assisting the normal formation of and subsequently inpreserving the teeth, and there would seem to be manyconditions in which an intelligent trial of the preparationmight be made.
Hœmatopan.—This drug is prepared in the laboratoryof Dr. A. Wolff, of Bielefeld (Agent : Mr. James Wandrum,Stow-street, Paisley), and is a combination of haemoglobinand malt. It has, we believe, been procurable for over20 years, but recently a good many reports of its beneficial ieffects in malnutrition have been received, with the resultthat an increased interest in the preparation is being mani-fested. Various combinations of hæmatopan with a smallpercentage of arsenic, with potassium bromide, calciumlactate, guaiacol, colloidal silica, and iodine are alsoprepared in accordance with the indications of the case.
Radiostol, which is now prepared by British Drug Houses,Ltd. (Graham-street, City-road, London), is an irradiatedergosterol and should be of service in making good dieteticdeficiencies, especially in cases of rickets. It is prepared inbottles of 50 tablets, each tablet containing an exact quantityof radiostol, while it is claimed that the original vitamin Dcontent is maintained. The radio-ergosterol is also issuedin solution where the antirachitic activity is estimated at50 times that of cod-liver oil. The preparation is clearlyone upon which systematic reports might be made withprofit.We have received from Messrs. Coates and Cooper, of
Great Tower-street, London, acting as agents for Messrs.Reed and Carnrick, of Jersey City, U.S.A., samples of
Peptenzyme in what is termed " elixir form." The prepara-tion is designed to be used as a vehicle for noxious and dis-tasteful drugs with which it is usually readily miscible.It is neutral in reaction, low in alcoholic content, and is
stated, as its title conveys, to contain certain enzymesvaluable in digestion.
A HOSPITAL PHARMACOPŒIA.THE Pharmacopoeia, of the Paddington Green Children’s
Hospital, revised last December, has been reissued as a slimvolume of 19 interleaved pages. Formularies of this kindreflect more or less faithfully the accumulated traditionsof a serviceable routine. The detached reader picking upthe volume before us may pardonably query such not veryhappy pieces of latinity as Collyrium Borozinci and PulvisRhei cum Sodio, and may wonder what is designated byOleum Dulce ; but in all probability such cruxes do notexist for members of the hospital staff. The book is compre-hensive in its scope, particularly as to its lotions, mixtures,and ointments ; it will be helpful if in future editions theage for which the dose of each internal medicine is prescribedis indicated.
CHILDREN’S DECORATIONS FOR CHILDREN’SWARDS.
THE T4’orld’s Health (the organ of the League of RedCross Societies) for February tells us that the children ofNew York schools (ages 10-14) were asked to send insketches of the pictures they would like to look at if theywere sick in hospital wards. Generally they favouredillustrations of fairy tales or nursery rhymes. A thousand wereexhibited and 500 were selected as remarkable for colourtones, mastery of design, and appeal to the imagination.These will be used in the children’s wards of the new medicalcentre which is a-building in New York, and should becompleted this year.
PROTEIN TREATMENT OF DRUG-ADDICTION.
WITH reference to an annotation with the above title,published in our last week’s issue (p. 350), Dr. Stanford Parkinforms us that he referred to the treatment of drug-addictionwith endocrine extracts in the annual report for Bay MountHome for 1925, and has since been making experiments withthe method. The low blood pressure invariably found indrug patients, he says, and other symptoms suggestingendocrine insufficiency, suggested the use of orchitic andsuprarenal extracts, and he has found them of considerablevalue in maintaining the strength and tone of his patients.Similar improvement has been noticed in a certain type ofsufferer from alcoholism.
ALKALI RESERVE AND THE COMMON COLD." DYSPEPTIC " writes : I read with great interest the
paragraph on the common cold from your Americancorrespondent last week (p. 370). I have been entirelyfree from colds for a great many years, but have suffered forabout the same length of time from a form of indigestionfor which large doses of various alkalis have been prescribed.Whether the theory put forth by Dr. Cheney is acceptableor not, I am prepared to be consoled by the thought thatthis continued treatment of the persistent digestive troubleis keeping at bay the common cold in my own case.
TWO USEFUL CONVALESCENT HOMES.
Catisfield House, Brighton.-The Catisfield Estate was
bequeathed by Miss Rose Greene to establish a convalescenthome for gentlewomen of limited means, especially forthose leaving hospital after an operation or acute illness.The home is run on the lines of a first-rate convalescenthome, and when necessary, medical attendance and medicineare provided free of charge. There is accommodation forseven patients, and a charge of from 30s. to £2 a head perweek is made, as the endowment is insufficient to pay thewhole expense of upkeep. The home has only been opentwo years, but when it is better known it should certainlybe always full. Patients suffering from phthisis, activecancer, infectious diseases, mental trouble, or drug habitare not admitted. Full particulars may be had from theMatron, Catisfield House, Sillwood-road, Brighton.
The Frederick Andrew Convalescent Home, West Malling,is run on the lines of a private house in the country, to whichare admitted for three weeks at a time gentlewomen whorequire convalescence after recent illness or operation.The stipulation is that they should be such as have to earntheir own living. No charge is made for admission, butpatients pay their own laundry and telephone charges.There is accommodation for 15 patients, each in a separatebedroom. The home is not a holiday resort, but is intendedto assist poor educated women to get back to the wage-earning ranks after illness. The following cases are
inadmissible : neurasthenia, infectious cases, chroniccases, cases requiring special dietary, surgical dressing, orthose suffering from any illness of an objectionable nature.Patients must be capable of dressing themselves, of gettingabout without help, and of attending meals in the dining-room. Full particulars may be obtained from the matron,Miss N. S. Townshend, A.R.R.C., the Manor House, West
Malling, Kent.
